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1083679104 NPI number — OMA L SHELTON CFNP

NPI Number: 1083679104
Health Care Provider/Practitioner: OMA L SHELTON CFNP

Information about “1083679104” NPI (OMA L SHELTON CFNP) exists in 1083679104 in HTML format HTML  |  1083679104 in plain Text format TXT  |  1083679104 in PDF (Portable Document Format) PDF  |  1083679104 in an XML format XML  formats.

NPI Number : 1083679104 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083679104",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHELTON",
    "FirstName": "OMA",
    "MiddleName": "L",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CFNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "NOLAND",
    "OtherFirstName": "OMA",
    "OtherMiddleName": "L",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "CFNP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "P.O. BOX 939",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOLIVAR",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "65613-0939",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "417-777-4800",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2230 S SPRINGFIELD AVE",
    "SecondLinePracticeLocationAddress": "SUITE H-J",
    "PracticeLocationAddressCityName": "BOLIVAR",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "65613-9133",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "417-777-4800",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/20/2006",
    "LastUpdateDate": "07/02/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "080074",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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